5. Scabies and pediculosis

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1. SCABIES AND PEDICULOSIS DR. BIJAY KR.YADAV Holly vision technical campus Shankhamul , Kathmandu

2. SCABIES Infestation of the skin caused by ITCH MITE Sarcoptes scabies var. hominis . The scabies mite has four pairs of legs and measures 0.3 mm in diameter. It lives its entire 30-day life cycle in and on the epidermis. Incubation period : 2-4 weeks Mode of transmission : Intimate prolonged contact Sexual transmission Fomite transmission

3. Sarcoptes scabei mite

4. Clinical features Common sites : Inter digital webs sides of the fingers, Volar aspects of the wrists Lateral palms Elbows Axillae Scrotum Penis Labia, and T he areolae in women

5. Severe itchy papules or vesicles U sually worst at night.( Noctural itch) Surrounding skin may be inflammed Some time on close examine burrow may be seen Face is usually not involved except in infants and immuni -compromised Usually secondary infectiona leading to pustules, crusting and fever is the presentation

6. Circle of Hebra

7. Burrows

8. WHO ARE AFFECTED? Immuno -compromised patients HIV Psychiatric disorder patients Down’s syndrome Under immuno-supressive therapy

9. Treatment All close contacts of the patient, even if asymptomatic should be treated Benzene Hexachloride ( BHC 1% lotion) - Scarb lotion Should be applied below neck over all body To be repeated for 3 nights Then bath the patient after 3 rd night and boil all his/her clothes, bed sheets, etc Permethrin cream – to be applied over the lesion TDS to QID till the lesion is cured. Additional medications – Antihistaminics : for itchings as Tab. Cetrizine 10 mg Po HS Antibiotics : as Ampicillin/ cloxacillin in case of secondary infections Oral therapy with IVERMECTIN 200 microgram / kg single dose

10. Prevention Maintain the proper personal hygiene. Proper handwashing practice. Treatment and proper isolation of the case

11. Complications Secondary infection leading to pus formation, fever, lymphnode enlargement. Norwegain scabies : Extensive lesions Pustules, crusting Also involves face Seen in diabetic, immuno -compromised, kidney disease patients.

12. Pediculosis Pediculus humanus var. humanus (body louse) and P. humanus var. capitis (head louse). Head lice infestations occur worldwide and are most common in school-aged children Common among children 3 to 12 years of age

13. Types : Pediculus humanus : Two varieties Pediculus humanus corporis Pediculus humanus capitis Phthirus pubis : The gravid louse lays a few egg daily, these eggs are called nits. They are small-oval greyish white & 0.5 mm in length.

14. 1. Pediculosis capitis : It is the infestation of the scalp by pediculosa humanus capitis . It localizes in the scalp , favouring the occiput & temporal area. They are laid close to the scalp surface, at the bottom of the hair. Clinical features : Itching Scratching causes trauma with result into oozing. Secondary infection usually resulting in pustulation & absscess formation.

15. 2. Pediculosis corporis : It is the infestation of the body by pediculosa humanus corporis . The body louse inhibbits from the clothings . Lice bites the skin to suck blood Release of mild toxin Produces pruritic spot & strong itching Results in excoriations ( Hall mark of the disease) Sites : Shoulder Trunk Buttocks

16. 3. Pediculosis pubis : This is the infestation of the pubic & perianal hairs by phthirus pubis. It is usually transmitted by sexual contact. The adult female lays eggs & nits remain firmly adhered to the pubic hair. Clinical features : The patients complains of itching which results in scratching. The hairs may be matted in the thick crusts of dried pus, serum & blood. The patients may also notice tiny blood spot on the underwear.

17. Investigation / Diagnosis : The diagnosis is usually suspected on clinical examination & finding the nits or the adult louse on the hair of the fibers in the seams of the clothing, if necessary the hair of the fibers may be observed under the low power microscope.

18. Treatments : Pediculosis capitis : 1% Gamma benzene hexacholoride 25% Benzyl benzoate 0.5 % malathion Mode of applications : Three applications on the consecutive days followed by tying a cloth on the scalp. Shampoo after 7 days.

19. 2. Pediculosis corporis : Patients needs a scrub bath. Insecticidal dusting powder should be applied to the garments lying close to the skin. Laundering & ironing of the clothes. 3. Pediculosis pubis : 1% Gamma benzene hexachloride 25% Benxyl benzoate 0.5% malathion Since application is usually sufficient, if necessary repeat after 3 days.

20. Other treatments modalities : Maintain good hygiene Secondary bacterial infection treated with broad spectrum antibiotics Itching controlled by antihistaminics